This article contrasts the prevailing model for assessing and improving medical care - the quality of care paradigm - with an alternative approach - the patient accountability paradigm. The first approach is technocratic: it measures and promotes the quality of medical care through technical and...

Since the late 1960s the U.S. has attempted to develop a strategy for controlling the rate of growth of health care spending. During the 1970s this strategy relied heavily on various forms of regulation. Some regulatory programs were partially successful in moderating spending increases, but...

The author examines the potential role for the public and, more specifically, for plan participants, in making managed care organizations (MCOs) respond to their wishes by means other than market exit. Market exit, or simply choosing an alternative means of procuring healthcare, is not an option...

If we adopt a full consumer model for our healthcare system, we will incorporate not only the positive elements of consumerism but some negative ones as well. These negative aspects are often overlooked. This essay examines the negative side. In brief, health care consumers are only entitled to...

In this essay I argue that rational evaluation of evidence plays an important role in medicine, but that it is not an alternative to medical politics. Rather, evidence is a tool for institutional control and policy argument. Today evidence-based medicine is used to oversee individual physicians...

This article analyzes the concept of accountability and the role that managed care organizations play in promoting accountable health care. It examines the challenges to promoting accountable health care by analyzing conflicting goals within managed care and the conflicting interests of various...